Evidence of meeting #56 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was process.
A recording is available from Parliament.
5 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
At the session the Committee held on Monday, we heard two young women telling us the story of their mother, who, suffering from cancer, did not have access to a drug that had been subject to prior testing in a pilot study. The doctor simply said to the patient that he was crossing his fingers in the hope that the drug would be approved.
What do you think about this sort of situation, where the family was dealing with a serious illness, with cancer?
5 p.m.
Prof. Devidas Menon
I would feel exactly the same way. From the point of view that I bring here, as a researcher, I don't have the answer to the question.
Quite frankly, personally, I'm here today to speak to you because of drugs. I spent the first 10 weeks of this year in hospital, six of those weeks in intensive care. So I can identify very much with those individual situations. And I think that's where we run into a problem, pooling everyone into populations and ignoring that they're individuals. Somehow one has to be able to accommodate that, and that's not really through the science of big controlled trials.
5 p.m.
Author and Professor at Lionel-Groulx College, As an Individual
Anyhow, in Canada there are ways of having access to experimental drugs.
Suppose someone has HIV and all the drugs he has taken up to now are not working anymore. If a new drug arrives on the market and is promising, even though it may also have undesirable effects, that we do not know everything about, if the person, who is in the terminal phase or about to die, wants to try it out, I do not think we can stand in his way.
The same is true for someone, for instance, who is in the terminal phase of cancer. We are talking here about very serious cases. We are not talking about problems like arthritis, for which drugs that have already been proven are on the market. You can market a new product, whose undesirable effects you are not aware of, when there are drugs that have already been proven.
Dr. Graham of the Food and Drug Administration, the FDA, said though that the first thing he learned at medical school was never to be the first to test a new drug. When a disease is not life-threatening—In my case, I would not be the first to try out a new drug. In other circumstances, however, it may be different.
5:05 p.m.
Conservative
The Chair Conservative Rob Merrifield
Thank you very much.
We'll close off this session with the final questioner, Mr. Fletcher. You have four minutes.
5:05 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Thanks very much, Mr. Chair, and hopefully those are metric minutes.
I have a couple of questions. One deals with transparency. In the CDR, the issue of commercial confidentiality is imposed by the manufacturers. Is that the case in other jurisdictions as well, that the manufacturers say you can't show this or that?
5:05 p.m.
Assistant Professor, Centre for Health Services and Policy Research, University of British Columbia
Yes, it is, and I think we need to engage in dialogue, for instance, with people from the U.K., because the disclosure documents that NICE produces actually have a lot more information than the CDR is able to produce. And believe me, I've interviewed members of the CEDAC, and they'd love to put out more information. They just feel like they are restricted, not unlike Health Canada is restricted in how much it can disclose around a regulatory process.
5:05 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
It seems that the concern of the manufacturers is that the information is going to get out. If it's out in one part of the world, it's out. So why not just release it in Canada? Because the competition is going to have it. What's the push-back from the manufacturers to that statement?
5:05 p.m.
Assistant Professor, Centre for Health Services and Policy Research, University of British Columbia
That's an important policy process, right—I mean, pointing people towards where the information is. That's what we might do. But I also think we should collaborate and cooperate and work with the manufacturers to say, what's a reasonable level of disclosure?
5:05 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Just to shift gears for a moment, the issue of values plays into this whole discussion in a big-time way, although I don't think we've really discussed it thoroughly in our review as a committee. The values of quality of life and quantity of life—somehow putting a quantitative value on that is something that happens all the time, I suppose, in one way or the other. But when it comes to prescription drugs it seems to be more up front.
I wonder if the panel members could provide some guidance to the committee on how other jurisdictions deal with these value assessments and what you would recommend this committee do to make sure that issue is addressed properly in our report.
5:05 p.m.
Prof. Devidas Menon
I'll give you a brief answer to that, if I may.
To begin with, the whole issue of quality of life and values are not identical. Quality of life is in fact measured scientifically in many of the drug and even non-drug technology trials. There are validated methods of doing that, to see if there is an improvement in quality of life in a particular patient population. Suddenly, values are connected with that, but values as such have never been explicitly discussed to any extent by almost any of these bodies. I think it's only in the last three to four years that this has come up, and the international agencies for health technology assessment are beginning to try to understand where and how values could be introduced.
Then it becomes a methodological sort of question: how do you seek them, how do you elicit them, and from whom do you do this? Part of my research program is to try to incorporate citizen engagement in cancer drug decision-making. We've just received a five-year grant from CIHR to create a new team to do this. So in my view, it's still very early days for us in incorporating values into health care resource allocation decision-making. I don't think we have a great example that we can point out to follow. This is where I think Canada can again take the lead, as it has in the past.
5:10 p.m.
Conservative
The Chair Conservative Rob Merrifield
Does anyone else wish to comment?
That's a touchy one anyway.
We'll call it there as far as the questioning is concerned.
We want to thank our witnesses for coming in. Your presentation has been very valuable to us as we work towards a report with regard to the CDR and this important study, so we want to thank you for coming in and contributing to that.
We'll now break for a moment or two as we move in camera for discussion on future business and our report.
Thank you very much.
[Proceedings continue in camera]